Q: What is the first line of treatment in severe life-threatening babesiosis?

A) IV Vancomycin
B) PO Doxycycline plus IV Penicillin 
C)  Oral quinine plus intravenous clindamycin
D) IV or oral linezolid
E) Supportive treatment 


Answer: C

Three regimens have been described for the treatment of severe (life-threatening)  babesiosis

1. Oral quinine plus intravenous clindamycin
2. Atovaquone plus azithromycin
3. Atovaquone plus azithromycin plus clindamycin

 Infectious Diseases Society of America (IDSA) guidelines, recommend oral quinine plus intravenous clindamycin as a first line of therapy.


References:

1. Sanchez E, Vannier E, Wormser GP, Hu LT. Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: A Review. JAMA 2016; 315:1767

2. Wittner M, Rowin KS, Tanowitz HB, et al. Successful chemotherapy of transfusion babesiosis. Ann Intern Med 1982; 96:601.